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1、NCDs 2030:Accelerating Change through InnovationW H I T E P A P E RN O V E M B E R 2 0 2 2In collaboration with Duke Kunshan University Global Health Research CenterContentsForewordExecutive summary1 Introduction 1.1 PLWNCDs are more vulnerable to COVID-191.2 Challenges in service provision for NCD

2、management1.3 Strengthening health systems with NCD management2 Responding to NCD management challenges during the pandemic 2.1 Increasing temporary facilities to mitigate the impact on hospitalized NCD patients2.2 Improving efficiency to meet PLWNCD outpatient needs2.3 Adopting flexible measures to

3、 ensure the accessibility of NCD medications3 The transformation to integrated health systems3.1 Reshaping the diagnosis and treatment process in a people-centred way3.2 Improving efficiency by developing and applying innovative technology3.3 Focusing on early detection and diagnosis4 Recommendation

4、s4.1 Lessons learned from COVID-19 for health service models4.2 Optimizing diagnosis and treatment pathways to improve efficiency4.3 Building a health ecosystem and improving the continuity of health services4.4 Integrating digital health technology with primary healthcare to improve accessibility4.

5、5 Strengthening global public and private collaboration with an open and inclusive mindsetAppendix:Experts consultedContributorsEndnotes34556677889101620222222232323242526Cover:Olemedia,Getty Images Inside:Getty Images 2022 World Economic Forum.All rights reserved.No part of this publication may be

6、reproduced or transmitted in any form or by any means,including photocopying and recording,or by any information storage and retrieval system.DisclaimerThis document is published by the World Economic Forum as a contribution to a project,insight area or interaction.The findings,interpretations and c

7、onclusions expressed herein are a result of a collaborative process facilitated and endorsed by the World Economic Forum but whose results do not necessarily represent the views of the World Economic Forum,nor the entirety of its Members,Partners or other stakeholders.NCDs 2030:Accelerating Change t

8、hrough Innovation2ForewordThe COVID-19 pandemic has exposed the vulnerabilities of global and national health systems.Already-struggling healthcare systems have shifted their resources to the pandemic response,which has exacerbated the burden on people with non-communicable diseases(NCDs)by delaying

9、 and disrupting their diagnosis,treatment and care.NCDs,also known as chronic diseases including cardiovascular diseases,cancers,chronic respiratory diseases and diabetes remain the number one killer globally,causing nearly three-quarters of deaths worldwide.Every year,17 million people under the ag

10、e of 70 die from NCDs,86%of whom live in low-and middle-income countries.1 The 2030 Agenda for Sustainable Development recognizes NCDs as a major challenge for sustainable development.As part of the Agenda,global leaders have committed to developing ambitious national responses by 2030 to reduce pre

11、mature mortality from NCDs by one-third through prevention and treatment(SDG Target 3.4).2,3At the time of writing,in November 2022,as the pandemic appears to be in transition,it is the optimal moment to reflect on lessons learned.More importantly,it is now time to consider what practices could be a

12、dopted from the pandemic response to create more resilient health systems in developing countries in the long term.COVID-19 offers a chance to reset health system priorities,providing a leapfrogging moment for health system transformation through innovation.As COVID-19 transitions,developing countri

13、es will have an opportunity to improve the equity,accessibility,quality,efficiency and resilience of their health systems.Non-communicable diseases present an urgent global health challenge.Governments,private-sector industries and international organizations must work together to strengthen their c

14、ollaboration,with learning and sharing at the heart of this ethos.There is no better time for the world to unite and align efforts under these principles.Shyam Bishen Head,Shaping the Future of Health and Healthcare,World Economic ForumNCDs 2030:Accelerating Change through InnovationNovember 2022Yun

15、guo Liu Co-Director,Global Health Program,Duke Kunshan University Global Health Research CenterNCDs 2030:Accelerating Change through Innovation3Executive summaryFor this report,in-depth consultations with policymakers,industry leaders and leading academics from G20 countries were conducted to uncove

16、r lessons learned,effective methodologies and innovation strategies and the results inspire optimism.Developing countries have reacted rapidly to NCD management challenges by increasing health service provision and strengthening medicine supplies in response to the multifaceted knock-on effects of C

17、OVID-19.The paper examines how,with thoughtful planning and careful implementation,some of these rapid responses can,and should,be made permanent to improve the equity,accessibility,quality,efficiency and resilience of health systems.Examples of replicable responses include the many promising exampl

18、es of people-centred integrated care models across the disease spectrum;innovative attempts to enable and mobilize community-level primary care for early screening and diagnosis;and smart integration with digital and technological advancements to increase health access and improve diagnosis and trea

19、tment.There is still room for optimization,but we already see trailblazers identifying cost-effective and globally applicable NCD intervention and treatment pathways from which every country no matter its income level can and should benefit.As the report sets out,to achieve progress and the goal of

20、universal health coverage,we must reflect openly and honestly on the lessons learned so that gaps can be identified and new priorities set.We should move towards a people-centred integrated care model and create an ecosystem where digital and technological advancement can be integrated into each pat

21、ients journey and into primary care institutions to improve access and quality of care.Taking an ecosystem approach will require global public and private collaboration.Only by doing so can we save lives,reduce health system burdens and collectively achieve SDG Target 3.4.Carrie Liu Lead,Health and

22、Healthcare,World Economic ForumKelly McCain Head,Healthcare Initiative,World Economic ForumNCDs 2030:Accelerating Change through Innovation4Introduction1COVID-19s long-term and detrimental impact on NCD management has necessitated active health system reforms in developing countries.As of 20 Septemb

23、er 2022,the global COVID-19 pandemic had resulted in 618,155,539 cases of the disease around the world,leading to 6,533,516 deaths.4 Since its emergence,COVID-19 has produced widespread social and economic uncertainty on a global scale.Health systems have been under enormous pressure,notably due to

24、the impact of the virus on people living with non-communicable diseases(PLWNCDs)and the difficulties it caused for the management of NCDs(cardiovascular diseases,cancers,chronic respiratory diseases and diabetes,as well as mental health disorders).Developing countries,which account for more than 80%

25、of the global disease burden of NCDs,5 are exposed to the exacerbated impact of COVID-19 as they often suffer from a lack of health service resources and capacity.6PLWNCDs are more likely to be infected with COVID-19 compared with healthy people;7 in addition,the disease progresses faster,and the lo

26、ng-term health effects are more severe,in these people.Some 6090%of COVID-19 deaths can be attributed to one or more NCD comorbidities.8,9,10 PLWNCDs are also affected by the pandemic in terms of their mental health,showing a higher probability of concurrent anxiety and depression.11 On top of this,

27、some chronically ill patients voluntarily reject treatment because they fear that going to the hospital will increase the risk of infection.PLWNCDs are more vulnerable to COVID-191.1NCDs 2030:Accelerating Change through Innovation5In addition to the direct impact of COVID-19 on individuals health,PL

28、WNCDs also face challenges relating to health service accessibility.Many countries and regions have established closed and isolated control measures to prevent susceptible individuals from being exposed to infection and to help stop the spread of COVID-19.In May 2020,the World Health Organization(WH

29、O)conducted a rapid assessment of service delivery for NCDs during the COVID-19 pandemic.The results showed that,out of 163 countries and regions surveyed,122 countries or regions reported chronic health service interruption;cardiovascular emergency services were interrupted in 31%of the countries,c

30、ancer treatment services were interrupted in 42%and treatments for hypertension were interrupted in 53%.12 On top of this,pandemic prevention and control measures have had a knock-on effect on medical resources for NCD management services,leading to insufficient capacity in primary healthcare instit

31、utions,and issues with the supply of drugs for NCDs.Challenges of service provision for NCD management1.2As one of the Sustainable Development Goals adopted by all United Nations member states in 2015,SDG 3.4 seeks to reduce premature mortality from NCDs by one-third by 2030 through prevention and t

32、reatment and to promote mental health and well-being.13 As yet,few countries have succeeded or even come close to reaching this target.14 It is clear,however,that improving the capacity and efficiency of NCD management and transforming health systems are vital objectives for developing countries,bot

33、h for their inhabitants health and for global sustainable development.Fortunately,the practices involved in improving NCD management capacity also contribute to the strengthening of health systems in general.At the macro level,NCD management requires interdisciplinary collaboration,which provides an

34、 anchor point for health systems to implement comprehensive and high-quality development strategies.Specifically,NCD management begins with enhancing community healthcare services;this helps to solidify the“cornerstones”of a health system15 healthcare delivery,health information systems and medicine

35、 supply security enabling it to cope with the double threat of communicable and non-communicable diseases16 and better prepare for a future pandemic.Strengthening health systems with NCD management1.3NCDs 2030:Accelerating Change through Innovation6Responding to NCD management challenges during the

36、pandemic2Health systems have adopted flexible response methods to mitigate the impact of the COVID-19 outbreak.In order to minimize the impact of the pandemic,developing countries and regions have developed rapid response plans to maintain regular in-and outpatient services,as well as secure drug ac

37、cessibility for PLWNCDs.Certain countries or regions have adopted a system whereby some hospitals have become designated centres for treating COVID-19 while others maintain normal operations as much as possible,treating patients with NCDs who are not infected with COVID-19.Such a two-pronged respons

38、e method helps ensure the continued supply of medical services when infection cases are scattered.However,when there is a large-scale outbreak of infections,a serious shortage of hospital beds will ensue.Increasing temporary facilities to mitigate the impact on hospitalized NCD patients2.1NCDs 2030:

39、Accelerating Change through Innovation7In 2020,China took the lead by building a new“mobile cabin hospital“in Wuhan.The pressure on normal medical resources was reduced by increasing the medical resources used to treat patients with COVID-19 on a large scale in a short period of time.Serbia,India,In

40、donesia and others17,18,19,20 have also adopted similar approaches,building new facilities for the isolation and treatment of patients with COVID-19 to ensure that the medical needs of patients with NCDs can also be met.21Faced with a shortage of medical resources,health systems in some developing c

41、ountries and regions have placed more emphasis on improving service efficiency.During the pandemic,medical institutions in these areas paid more attention to the role of pre-examination and triage,optimized the process of diagnosis and treatment service provision for PLWNCDs.Some countries have form

42、ulated guidelines or expert consensus on the diagnosis and treatment of various NCDs during the pandemic to improve the standardization of services.22,23,24,25 Patients are encouraged to obtain appropriate services through primary healthcare institutions,while community health service centres and fa

43、mily doctors interact with patients or their families and provide follow-up services through social media tools.During the pandemic,especially the period of high incidence of infection cases,the internet became an important asset in relieving the pressure on physical hospitals.“Contactless“healthcar

44、e services provided by internet healthcare sites reduced the risk of infection for patients who usually visited physical hospitals,as well as meeting PLWNCDs home treatment and medication needs.Improving efficiency to meet PLWNCD outpatient needs2.2PLWNCDs generally require long-term medication.Some

45、 measures to guarantee the supply of medication of PLWNCDs include:Using designated pharmacies as the main channel for medication supplies to PLWNCDs:Taking China as an example,Wuhan identified 50 designated retail pharmacies across the city after the outbreak of COVID-19 to serve PLWNCDs.26 Cities

46、such as Shanghai,Beijing and Jilin also relieved medicine supply issues through the use of designated pharmacies for NCD treatments.27,28 Extending the time limits for prescriptions for PLWNCDs and implementing a“long prescription”policy:In 2020,Chinas National Medical Security Administration extend

47、ed the prescription dosage for hypertension and diabetes from two months to three months to ensure the long-term medication needs of PLWNCDs were met.29 Some regions also encouraged physicians in primary healthcare institutions or contracted family doctors to issue prescriptions,which normally come

48、from overloaded hospitals.Local health commissions are responsible for developing the list of medicines suitable for“long prescriptions”and the relevant policies,30 while pharmaceutical companies have also launched large-package versions of NCD medications,for“long prescriptions”.31 Providing door-t

49、o-door medicine delivery services to reduce social contact:Door-to-door medicine delivery services for eligible elderly PLWNCDs through community health service staff,community volunteers or drug delivery companies have been encouraged.A number of internet technology companies have collaborated with

50、 pharmacy chains to launch online pharmacies,which allow patients to arrange to have medicines delivered to their homes in 30 minutes using a smartphone app.As tools to deal with the impact of the pandemic in the short term,these measures can reduce the pressure on NCD management to a certain extent

51、.However,as things normalize,health systems in developing countries and regions need more proactive innovation and systematic transformation,if only to better prepare for a future pandemic.Adopting flexible measures to ensure the accessibility of NCD medications2.3NCDs 2030:Accelerating Change throu

52、gh Innovation8The transformation to integrated health systems3Transforming health systems requires a three-pronged approach focusing on people,technology and prevention.Universal health coverage(UHC)is a priority for the development of global health governance and national health systems,and is key

53、to achieving the health-related SDGs.The WHO proposed a working definition of“integrated people-centred health services”(IPCHS)in 2016 and called on member states to provide health services in a more integrated and people-centred manner,32 which it sees as critical to achieving the goals of UHC.Due

54、to the scarcity of high-quality medical resources and the greater social and economic pressures caused by NCDs in developing countries,there is an urgent need to establish high-quality,efficient health systems within them.NCDs 2030:Accelerating Change through Innovation9Reshaping the diagnosis and t

55、reatment process in a people-centred way3.1CPCs:reducing the onset-to-treatment time and improving acute chest pain patient treatment efficiencyChina started building chest pain centres(CPCs)in 2011 and in 2013 established a CPC certification system,with the goal of establishing a mechanism for“send

56、ing patients with acute chest pain to a hospital with the ability to receive the best treatment in the shortest possible time”.To achieve this goal,a series of measures in Chinas CPC model facilitate the seamless integration of acute chest pain treatment systems in the pre-hospital,in-hospital and p

57、ost-hospital phases to reduce the emergency response time,which may provide a useful reference for developing countries.The CPC emergency map mini-app on WeChat enables users who experience sudden chest pain to quickly locate the nearby chest pain centre and call the 120 emergency service with one c

58、lick.An ambulance,with the support of an intelligent transport system combined with information on hospital percutaneous coronary intervention(PCI)admission capacity,will then take the patient to the nearest hospital with treatment capacity as quickly as possible.On the way to the hospital,emergency

59、 personnel can use the electrocardiogram(ECG)machine,multi-function monitor and other equipment located in the ambulance to conduct real-time detection of the patients vital signs and transmit the information to the hospital.On receiving the patients report,the doctor on duty will conduct a remote i

60、nitial diagnosis as soon as possible.If the patient is diagnosed with acute myocardial infarction,the on-board emergency personnel will immediately provide the patient with preoperative drugs for PCI and begin preparations for the person to be operated on after admission.On arrival at the hospital,t

61、he patient will be sent directly to the catheterization room through a prioritized access system for treatment.For patients who come to PCI-non-capable hospitals,the CPC emergency command centre will transfer the patient to a PCI-capable hospital as soon as possible;in PCI-capable hospitals,an emerg

62、ency nurse will evaluate the patients vital signs within five minutes,with the first ECG being completed within 10 minutes.This will then be assessed by a professional physician.Patients diagnosed with acute myocardial infarction will also be assigned to PCI as soon as possible.Cardiovascular diseas

63、es cause the largest number of deaths in the world.There are about 330 million patients in China,with three out of every 1,000 people dying of cardiovascular disease every year.Among them,acute myocardial infarction(AMI),the main clinical manifestation of acute chest pain,is an important cause of de

64、ath from cardiovascular disease.33 It is crucial for patients with AMI to receive standardized treatment as soon as possible after the onset of symptoms.Minimizing the time for early treatment is the most effective way to save lives.For this purpose,developed countries such as the United States,the

65、United Kingdom,Germany and Australia have established CPCs,and large number of studies have shown that CPC certification is associated with slower disease progression and better patient outcomes for those with AMI.34,35,36The CPC model in developed countries is based on a relatively robust emergency

66、 system,as well as community and on-site rescue capabilities.37 In comparison,the pre-hospital emergency system in developing countries is generally less established,the service capacity of primary medical institutions is insufficient,and the ability to diagnose and treat varies greatly.The develope

67、d countries model is not fully applicable to developing countries.Chinas CPC model might be a solution as it is based on the regional treatment network and focuses on the goal of reducing the total ischemic time(TIT the time from the onset of chest pain to the first balloon inflation during primary

68、PCI)of patients.It realizes the full potential of medical institutions on different levels,establishes a cooperative relationship with the emergency medical service(EMS)system and the transport department,and standardizes the patients treatment process.The key elements of Chinas successful CPC syste

69、m that are applicable to developing countries include:Establishing an effective regional treatment network:The density of CPCs has been increased and a CPC treatment network with a certain scale has been established in China.Additionally,the countrys CPCs use information technology to ensure data sh

70、aring between medical institutions at all levels and the emergency call system,and to connect the pre-hospital emergency system with in-hospital prioritized access.NCDs 2030:Accelerating Change through Innovation10 Developing a classified certification system:Different from the accreditation standar

71、ds of the United States and Germany,Chinas CPCs have two separate versions of accreditation standards:the standard version is suitable for medical institutions with primary percutaneous coronary intervention(PPCI),which is the most effective treatment for acute ST-segment elevation myocardial infarc

72、tion(STEMI).The grassroots version is suitable for primary hospitals without PPCI capability for the time being.At the same time,establishing standardized chest pain treatment units in primary medical institutions(town health centres,community hospitals,etc.)is advised.Continuously improving key ind

73、exes:The evaluation and treatment of patients with acute chest pain must conform with treatment pathways recommended by clinical diagnosis and treatment guidelines.On this basis,through cooperation with provincial and municipal health administrative departments,a national-provincial-municipal three-

74、level quality control system is established,and key monitoring indicators are determined for medical institutions at each level to ensure continuous improvement of medical quality.Apart from facilitating timely treatment,the regional treatment network model also contributes to better long-term patie

75、nt management.After discharge,patients will be re-examined and followed up according to post-hospital risk stratification assessments.High-risk patients will be scheduled for re-examination and follow-ups at secondary and tertiary hospitals,while medium-and low-risk patients will be diverted to prim

76、ary medical institutions.As of the end of 2021,a total of 5,151 medical institutions across China have started building CPCs,of which 2,096 hospitals have passed accreditation(1,047 standard CPCs and 1,049 primary CPCs),covering all provinces and 96%of counties.Service flow of chest pain centres in

77、ChinaFIGURE 1Pre-hospitalIn-hospitalPost-hospitalCall the emergency centreAmbulance transportand emergencyremote diagnosisNon-PCI hospitalRisk stratificationof the patientFollow-up visitHighModerateLowChest pain centreFollow-up visitFollow-up visitTertiaryhospitalSecondaryhospitalPrimary medicalinst

78、itutionRegular follow-upFollow-up routineReferral to lower-level hospitalReferral to higher-level hospitalScreen andconfirm the eligiblePCI hospitalIntelligenttransportationsystemPerform corresponding standardized diagnosisand treatment as for other patientsDeliver STEMI patient directly to PCI cath

79、 lab through the green channelRemotetransmissionof initialdiagnostic reportElectronic medicalrecords viaintelligentvoice controlSource:China Healthcare IoT Innovation CenterNCDs 2030:Accelerating Change through Innovation11Door-to-wire(D2W)time for STEMI patients undergoing direct PCI(minutes)FIGURE

80、 278737175749280767877010203040506070809010020172018201920202021Standard-version CPCBasic-version CPCSource:China Chest Pain Center Quality Control Report(2021)Since the establishment of CPCs,the average door-to-wire(D2W)time for STEMI patients undergoing PPCI has continued to decline from 115 minut

81、es in 2012 to 74 minutes in 2021(77 minutes for the primary CPC).In 2020 and 2021,due to the impact of COVID-19,CPCs in China still maintained the same level of treatment capacity as in 2019,38,39 even under strict pandemic control measures.The highest in-hospital mortality rate of STEMI patients wa

82、s 4.7%,which is significantly lower than the STEMI mortality rate during the pandemic in other countries.40,41,42NCDs 2030:Accelerating Change through Innovation12In-hospital mortality of STEMI patients(%)FIGURE 33.293.483.393.904.053.850.000.501.001.502.002.503.003.504.004.50201920202021Standard-ve

83、rsion CPCBasic-version CPCSource:China Chest Pain Center Quality Control Report(2021)MMCs:improving follow-ups and management of diabetes patients through one-stop servicesAccording to 2021 statistics from the International Diabetes Federation(IDF),537 million adults worldwide suffer from diabetes,8

84、1%of whom are patients in low-and middle-income developing countries.There are 141 million diabetic patients in China,43 meaning that 1 in 10 people in China suffer from diabetes.Once diagnosed,the patient requires frequent hospital visits to avoid further health complications,with multiple hospital

85、 departments usually being involved in a single visit.In addition,lifestyle(diet,exercise and medication usage)monitoring is as critical as the hospital visits.Chinas National Metabolic Disease Management Centers(MMCs)provide a streamlined solution:MMCs provide a“one-stop”service to patients,offerin

86、g hospital registration,risk assessment,complication screening,diagnosis and treatment,prescription and health education all in one place,among other options.The centres contain“all-in-one machines”,which integrate various examinations,enabling screening for all major conditions in about 30 minutes.

87、This removes the need to make multiple,unnecessary trips to different departments,as in traditional diagnosis and treatment scenarios.The patient receives an exclusive ID and their own electronic medical record on their first visit to an MMC,and all examination,diagnosis and treatment information in

88、 the hospital is stored in a centralized big data cloud platform.Daily health data(blood sugar,blood pressure,exercise,diet,etc.)recorded by Bluetooth-enabled devices can be integrated with hospital tests via the patients ID.Patients can then view this information through smartphone apps,while docto

89、rs and nurses can access it through workstations,medical-end applications and other tools.In this way,it becomes possible to conduct timely intervention and precise adjustments to patients diagnosis and treatment plans.With these tools,anytime-anywhere digital follow-up becomes a reality.MMCs across

90、 the country collectively form a four-level prevention and control network,including a national general centre and many regional,county and community centres.44 The general MMC is responsible for the development of standards and procedures as well as oversight of medical quality;the regional NCDs 20

91、30:Accelerating Change through Innovation13In-hospitalmanagementOut-of-hospitalmanagementMMC healthcarecloud serviceAICompletion of personal informationBasic informationMedical history andfamily historyExpertopinionsHome test kitsConvenientleasingMMC mobileterminalFamily datarecordsOutpatient appoin

92、tmentscheduling service with MMCsPatienteducationIndividuallypersonalized lifestylerecommendationsLatest research andupdated guidelinesOptimal treatmentplanBasicexaminationEndocrine-metabolicfunction diagnosticsAssessment ofrelatedcomplicationsUnique IDUniversal barcodeOne-stopexaminationAI-assisted

93、 physiciandiagnosis andtreatment systemEfficient datatransmissionMMCs are located within municipal hospitals and undertake the diagnosis and treatment of complex complications and acute and severe diseases;the county MMCs are located within county hospitals and conduct the diagnosis and treatment of

94、 mild to moderate complications;the community MMCs are responsible for the screening and management of high-risk groups.This four-level prevention and control network is conducive to leveraging the capabilities of different medical institutions in disease diagnosis,treatment and patient management.I

95、n order to achieve better continuous management of diabetic patients,MMCs have also developed the“1+X”model,in which a regional MMC or county MMC and three or more community MMCs establish a standard process of two-way referral;through telemedicine and staff training,the community MMCs are guided to

96、 provide efficient follow-up visits and disease management.In the early days of MMCs,only 21%of MMC diabetes patients HbAlc(a measure of blood glucose)reached the standard level recommended by clinical guidelines.Currently,among the 1.5 million people in the MMC system,the compliance rate reaches 50

97、%.The compliance rate for hypertension,hyperglycaemia and hyperlipidaemia has also increased from less than 10%to the current 17.9%.During the pandemic,MMCs continued to provide essential services by conducting online follow-up visits.Taking Shanghai as an example,in April 2022,69 medical institutio

98、ns with MMCs completed follow-up visits for 40,000 people within 10 days,and delivered critical medicines to hundreds of patients.Source:China Healthcare IoT Innovation CenterService flow of MMCsFIGURE 4NCDs 2030:Accelerating Change through Innovation14PatientCWMC inprimary carePatient educationarea

99、PrescriptionBack to clinicExaminationresultGeneral clinicAsthma clinicCOPD clinicComprehensive D&T:examination areaFamily rehabilitationareaStandard D&T:nebulization areaFilingScreeningPrint the reportMeasure the heightand weightTriageCWMCs:conducting whole-disease-course management to improve the q

100、uality of life for patients with respiratory diseasesCoughing and wheezing are common everyday symptoms,affecting 10%of the population.45 Many chronic respiratory diseases,including chronic obstructive pulmonary disease,asthma,bronchiectasis,pneumonia and lung cancer,share coughing and wheezing as t

101、he main symptoms.In reality,due to inconsistent diagnosis and treatment procedures and a lack of pulmonary function tests,a patient could be misdiagnosed with other respiratory system diseases,which could result in them being referred to the wrong specialist,or simply going undiagnosed.Worse still,a

102、s coughing and wheezing are very common symptoms,the patient often ignores them.Even if a patient has been diagnosed with chronic obstructive pulmonary disease(COPD),it is highly possible that the patient will stop taking their medication as soon as the symptoms subside.In some cases,the condition w

103、orsens due to a lack of follow-up consultations.Low awareness,low diagnosis rates and low follow-up rates are major barriers to the prevention and control of chronic respiratory diseases.In order to tackle these three barriers,Cough and Wheezing Management Centers(CWMCs)have been pioneered in China,

104、which operate as follows:Patients fill in a questionnaire about their symptoms before the first consultation.If appropriate,they will receive an appointment at a CWMC.Nurses will then guide patients through a pre-diagnosis risk assessment and screening.If the screening results are positive,clinical

105、diagnosis will be conducted according to the corresponding diagnosis and treatment path.Pre-diagnosis risk assessment can help improve patients awareness of their own symptoms and diseases,and improve follow-up examinations and treatment compliance,as well as the efficiency of doctors diagnosis.Pati

106、ents diagnosed with COPD,asthma or bronchiectasis will receive long-term management and follow-ups at the CWMC,including therapeutic solutions such as nebulizer therapy,desensitization therapy and/or rehabilitation therapy.Other services such as disease education and drug/device use guidance are pro

107、vided at the nurses workstation.After patients have received their hospital treatment,dedicated personnel are assigned to manage any post-diagnosis follow-ups using mobile or smart devices.CWMCs aim to achieve closed-loop management of both the hospital and home environment through the use of an int

108、elligent management platform and equipment,with the aim of reducing the frequency of hospital visits and improving patient compliance.Source:China Healthcare IoT Innovation CenterService flow of CWMCsFIGURE 5NCDs 2030:Accelerating Change through Innovation15Improving efficiency by developing and app

109、lying innovative technology3.2Even prior to the pandemic,digital health(the application of digital and information technology in the medical field)had been developing for decades.Digital health solutions include mobile health(mHealth),health information technology,wearable devices and telemedicine,a

110、s well as artificial intelligence(AI)and surgical robots.The need for telemedicine and computer-assisted decision-making existed before the pandemic,but the use of such technologies has accelerated since the outbreak.Whether it is supporting doctors clinical decision-making or helping patients acces

111、s medical services,the role of digital healthcare is becoming increasingly prominent,and will inevitably play an even greater role in the health systems of the future.Telemedicine:facilitating efficient connections between doctors and patientsThanks to the development and popularization of internet

112、technology and internet of things(IoT)technology,telemedicine has become one of the fastest growing sectors in the digital health space.Online consultations,real-time remote monitoring and remote medical guidance are all made possible by mobile devices as well as biosensors based on IoT technology.T

113、elemedicine helps to improve the accessibility of medical services for remote and under-resourced areas.For example,in Indonesia,the most populous country in South-East Asia,the ratio of doctors to the general population is 6.23 to 1,000,which is lower than neighbouring developing countries and sign

114、ificantly lower than that of developed countries(see Figure 6).Issues such as long hospital waiting times and inaccessibility of services fuel the demand for telemedicine.Taking the largest mobile health platform in Indonesia,Halodoc,as an example,users are provided with the following services throu

115、gh the mobile app:NCDs 2030:Accelerating Change through Innovation16 Easy access to doctor health consultation services:Users have access to 24/7 health consultation services through chat,voice or video calls.They can also upload medical reports in order to seek medical advice from qualified physici

116、ans,who receive training on how to interact with patients on joining the platform.Convenient drug purchase and delivery:Patients can have their drugs delivered in 45 minutes thanks to a collaboration between the relevant ride-hailing service company and e-commerce platform.Convenient insurance payme

117、nt:Users can use different payment methods,including government-funded insurance.Halodoc has signed a memorandum of understanding with Indonesias healthcare and social security agency(BPJS Kesehatan),which administers the countrys national health insurance(JKN),the worlds most extensive single-payme

118、nt system.Similar collaborations are also taking place between Halodoc and other commercial insurance companies.As in Indonesia,where several mobile health service providers offer patients convenient medical services through health apps,its common for countries in the South-East Asia/APAC region to

119、have multiple competing digital health platforms.46Medical doctors per 10,000 population in South-East Asia(2020)FIGURE 612.299.58.527.567.356.676.234.9902468101214Sri LankaThailandNepalTimor-LesteIndiaBangladeshIndonesiaBhutanSource:WHO,“Medical Doctors(Number)”:https:/www.who.int/data/gho/data/ind

120、icators/indicator-details/GHO/medical-doctors-(number)Key digital health platforms in South-East AsiaTABLE 1CountryKey digital health platformsIndonesiaAldokter,HalodocMalaysiaDoctorOnCall,Speedoc,Doctor AnywhereThe PhilippinesMedgate Philippines,HealthNow,SeeYouDocThailandDoctor Raksa,Doctor Anywhe

121、reViet NamViettel,Doctor Anywhere,VieVie HealthcareNCDs 2030:Accelerating Change through Innovation17Digital health services are also widely available in China,although digital health service follow-ups are allowed only for common diseases and NCDs.According to data released by the National Health C

122、ommission of China,as of June 2021 more than 1,600 internet hospitals were operating in China,while the year before the COVID-19 outbreak,there were only 100 nationwide.In 2020,the number of diagnosis and treatment services delivered through internet hospitals also showed a substantial increase.47Re

123、mote monitoring using IoT tech and biosensors enables more comprehensive services for patients.Continuous glucose monitoring(CGM)technology monitors the glucose concentration in subcutaneous interstitial fluid through a sensor,providing continuous,comprehensive and reliable information throughout th

124、e day.CGM is typically used by type 1 diabetes(T1D)patients,but in India,due to the large T2 diabetes population base,CGM is also frequently used for management,and has been widely adopted by doctors and patients alike.48An important advantage of the CGM is that blood glucose data obtained from moni

125、toring can be stored on the cloud,enabling healthcare professionals to view blood glucose data in real time.In addition,enabled by algorithms,integrating CGM with insulin pump technology could serve as an“artificial pancreas”,which could prevent potentially life-threatening hypoglycaemic conditions

126、and complications.How continuous glucose monitoring(CGM)worksFIGURE 7Medical device(sensor)Platform(network server)Medical feedbackPatient-generatedhealth dataSoftware as a medical deviceData-drivenmedical feedbackPlatform as data-mining engineData accumulationData analysisData analysisProvide servi

127、ces123Source:Lessons from Use of Continuous Glucose Monitoring Systems in Digital Healthcare:https:/pubmed.ncbi.nlm.nih.gov/32981296/NCDs 2030:Accelerating Change through Innovation18AI in healthcare:addressing doctor shortages and clinical decision-makingThe benefits of AI are clear:1)AI can be use

128、d to improve the accuracy of diagnosis and improve treatment outcomes,especially at primary medical institutions;and 2)AI is operable 24/7.Many low-and middle-income developing countries are faced with challenges such as insufficient medical resources,shortage of professional doctors,high misdiagnos

129、is rates and low diagnostic efficiency.AI technology,especially imaging technology,has the advantages of improved efficiency,accuracy and reliability.An experienced doctor needs one minute to assess 10 CT scan images.In contrast,AI technology using image recognition can shorten the time of assessmen

130、t to a few seconds while improving the accuracy of manual diagnosis by 1520%.49 In addition,AI technology standardizes diagnosis,as discrepancies can be created by human factors such as fatigue or inexperience.With reference to the content of clinical data collection,the application of AI medical im

131、aging can be divided into categories such as CT images,fundus images,X-ray fluoroscopy,pathological image analysis,ultrasound(US)images,endoscopy images,skin images,electrocardiogram(ECG)images and electroencephalogram(EEG).Applications of AI in diagnostic and therapeutic processesFIGURE 8During dia

132、gnosisAfter diagnosisBefore diagnosis Intelligent follow-up visits Intelligent NCD management Intelligent assisted diagnosis and treatment AI medical imaging diagnosis Medical robots Virtual health assistant Intelligent guidance Intelligent appointment Disease predictionDisease areas for AI medical

133、imaging applicationsTABLE 2ImagingDisease areasCTLung cancerRetinalDiabetic retinopathy,age-related macular degenerationX-rayFracture screening and bone age predictionPathological image analysisCervical cancer,breast cancer,gastric cancer,prostate cancerUltrasoundBreast cancer,thyroid cancer,liver c

134、ystsEndoscopeGastric cancer,colorectal cancer,oesophageal cancerECGArrhythmia,ventricular atrial hypertrophy,myocardial ischaemia,myocardial injury,myocardial infarctionNCDs 2030:Accelerating Change through Innovation19AI can be integrated into almost all aspects of a health service system.In additi

135、on to improving the efficiency and accuracy of diagnosis,it can also be used before and after diagnosis.Therefore,the application of AI algorithms can accurately match doctors to patients to optimize resources,and formulate personalized follow-ups.For example,in MMCs,three different mobile applicati

136、ons have been developed using AI technology,which are used for diabetes risk assessment,prediction of cardiovascular risk and provision of medical care recommendations for patients based on the current Standards of Medical Care in Diabetes.50Focusing on early detection and diagnosis3.3Large-scale ea

137、rly screening of high-incidence cancerThe WHO estimates that 3050%of cancers can be prevented by reducing risk factors and implementing evidence-based prevention strategies.Through early detection and appropriate treatment,many cancers have a high possibility of being cured.51 Nonetheless,very few d

138、eveloping countries have high-risk cancer screening programmes at the national level,and only a few countries mostly high-risk countries have national programmes that cover at least 70%of the population.52,53 These include prostate cancer screening schemes in Latin American countries such as Mexico,

139、Brazil and Colombia,and a breast cancer screening programme in Egypt.The Comprehensive Prostate Cancer Care Program(OPUS Program)initiated by the National Cancer Institute of Mexico,with the support of the federal government,provides preventive diagnosis(voluntary)for all men over the age of 40 thro

140、ugh a collaboration among medical institutions,NGOs and private enterprises.The programme has raised public awareness of the disease and provides corresponding treatment and follow-up services.In Egypt,as part of the 100 Million Healthy Lives Initiative launched by President Abdel-Fattah El-Sisi in

141、2019,women over 18 are offered free breast cancer screening services to raise awareness and allow early diagnosis.Among the large-scale cancer screening programmes in these two developing countries,there are some commonalities worth noting that may serve as a useful reference for other developing co

142、untries:Raising public awareness:In Mexicos prostate cancer screening programme,serious promotional efforts have taken place on TV,radio,Spotify and social media platforms such as LinkedIn and Facebook.The programme has invited high-profile football players to events,as well as organizing the“Dale l

143、a Vuelta Al Cancer de Prostata”campaign.Breast cancer screening in Egypt has been publicized through government and hospital promotions.The initiative is set in three stages,gradually expanding from an initial nine provinces to 27 across the country to ensure it receives the maximum attention and po

144、sitive outcomes.NCDs 2030:Accelerating Change through Innovation20 Accessibility of screening services:Egypt relies mainly on a large number of community hospitals and clinics to provide extensive screening service coverage.The country has 3,538 clinics offering breast cancer screening for women,wit

145、h another 114 hospitals supplying additional services.Mexico,on the other hand,uses vehicles with testing equipment to provide a mobile testing service in the community.As well as screening programmes for prostate cancer,it also carries out screening for NCDs such as diabetes,cardiovascular diseases

146、,and breast and lung cancer.End-to-end management services after screening:The results of early screening are meaningful only if treatment is readily accessible and available.In Mexico,if high-risk criteria are met,patients will be referred to the nearest laboratory for further testing and,based on

147、the results of the test,they will be referred to an appropriate hospital for treatment.In Egypt,suspected cases are referred for further examination and treatment for free,which is provided in 14 medical centres and 14 university hospitals overseen by the Egyptian Ministry of Health.A variety of pre

148、paratory tasks need to be undertaken before launching large-scale early cancer screening work.Among them,assessing the epidemiological data on common cancers and their main risk factors is the first step in formulating a plan.Egypt,for example,began to establish its National Cancer Registry,which pr

149、ovides accurate and complete data for screening programme planning,in 2007.In addition,the cost-effectiveness of early screening and testing programmes need to be evaluated to determine the appropriate populations,criteria and targets.Exploring innovative models of early screeningExperiences from co

150、untries such as Mexico and Egypt demonstrate that government support,community partnerships,identification of barriers to early detection,public awareness and media advocacy are all critical in establishing effective screening programmes.Access to services has largely affected the take-up rate for s

151、creening,and an exploration on how best to improve service access may be useful.Mobile screening solutions in Mexico have proven to be successful,while in remote rural areas and isolated cities in China,convenient and flexible breast cancer and cervical cancer screening services are being provided t

152、o women through screening vehicles that integrate digital mammography,colour Doppler ultrasound diagnostic systems and cervical HPV tests.Another approach is to take advantage of rapidly developing internet technology to separate out sampling and testing.Sampling could be undertaken in community hos

153、pitals with trained medical staff(cervical cancer screening),or done at home by patients themselves under guidance(e.g.for colorectal cancer).The self-testing journey is straightforward:after ordering and receiving the sample collection kit,the patient collects stool samples according to the user gu

154、idance and sends it back to the processing laboratory for a testing report.NCDs 2030:Accelerating Change through Innovation21Recommendations4As COVID-19 transitions,developing countries will have a leapfrogging opportunity to improve the equity,accessibility,quality,efficiency and resilience of thei

155、r health systems.At the same time,universal health coverage is a global priority as it is the key to achieving the health-related Sustainable Development Goals.In order to achieve the goals of UHC and the SDGs,developing countries also need to further optimize and improve their health systems.Lesson

156、s learned from COVID-19 for health service models4.1COVID-19 has put enormous pressure on health systems globally,yet society progresses by learning from past experiences.This is the optimal moment for collective reflection and for action on lessons that can be applied in the future.Some positive pr

157、actices include:“Grid-style”management(municipal governments administratively dividing urban areas into“grids”for better management and information sharing)Mobilizing community participation Encouraging individuals to practise self-health monitoring Conducting health education and peer education thr

158、ough social networks Continuing to refine long-term prescription guidance and reimbursement policy for NCD patientsFurther strategies include:using and optimizing infrastructures and capabilities developed during the pandemic to strengthen community-level primary care systems;making temporary health

159、 service facilities permanent to strengthen primary healthcare services at the community level;using PCR testing laboratories for early detection and diagnosis of other diseases,especially NCDs.The challenges countries face in maintaining their COVID-19 response while addressing competing public hea

160、lth priorities are clear.Consolidating COVID-19 clinical care pathways with primary healthcare systems and installing better coordination mechanisms among medical institutions are two ways to achieve the overarching goal of“integrating medical treatment service and public health services”.Optimizing

161、 diagnosis and treatment pathways to improve efficiency4.2Though each disease is unique,there are commonalities in diagnostic and treatment pathways.The success of Chinas CPCs has been replicated in other disease areas,resulting in heart failure centres,atrial fibrillation centres,hypertension compl

162、iance centres,cardiac rehabilitation centres and heart valve disease intervention centres.Standardization is the key.With standardized diagnostic tools,key indexes and processes,accuracy will improve across all areas,reducing redundancy to save costs and improve efficiency so that patients receive t

163、imely diagnosis and treatment.Developing countries should therefore prioritize diseases with the highest burden and gradually expand to additional diseases areas.NCDs 2030:Accelerating Change through Innovation22Building a health ecosystem and improving the continuity of health services4.3Screening

164、for high-risk factors,early disease diagnosis,standardized treatments and longer-term follow-up mechanisms are critical factors for the health of individuals and populations.Though doctors and medical institutions are the main gatekeepers,it is equally important to provide patients with evidence-bas

165、ed and cost-effective tools.A successful patient journey requires full ecosystem engagement,from developing diagnostic tools to working with monitoring and management tools.It is also crucial to explore and establish a well-functioning financing mechanism to support digital tools,which are an import

166、ant pillar of the system.Integrating digital health technology with primary healthcare to improve accessibility4.4The COVID-19 pandemic has once again demonstrated the significance of primary healthcare institutions,and the shortcomings of current capabilities.There is an urgent need to strengthen p

167、rimary healthcare to ensure more resilient health systems and achieve universal health coverage.Developing countries will have to increase their investment in capacity building at the primary healthcare level,including strengthening the training of medical staff.Digital technology provides the found

168、ation for leapfrogging a large number of administrative tasks can be automated by digital solutions,while AI-assisted diagnosis and treatments enhance service quality provided at the community level.A well-defined regulatory framework is also required to ensure data security and patient protection.G

169、overnments should also actively engage in creating a global framework for better regional and global collaboration.Strengthening global public and private collaboration with an open and inclusive mindset4.5Non-communicable diseases are an urgent global health challenge.Governments,private-sector ind

170、ustries and international organizations must work together to strengthen cross-regional,cross-industry and interdisciplinary collaboration.Global health collaboration should come not only in the form of foreign aid,but also provide equal opportunities for countries to voice specific challenges and d

171、ifficulties,share learnings and best practices in peer-to-peer exchanges,and highlight achievements in policy innovation,health system integration,health workforce education and training,and innovative medical technology development.Global health cooperation 2.0 must place learning and sharing at th

172、e heart of this ethos.There is no better time for the world to unite and align efforts under these principles,using our collective wisdom and resources.Only by doing so can we tackle NCDs as well as preparing for any future health crises that we may face.NCDs 2030:Accelerating Change through Innovat

173、ion23Appendix:Experts consultedHamdy Abdel AzimChairman of Kasr Al-Ainy School Of Oncology(KASO),Department of Oncology,Faculty of Medicine,Cairo University Sujie CaoDeputy General Manager of International Medical Division,BGI Genomics,ChinaXiaoyu GuanDirector,Headquarter of Chest Pain Centers,China

174、Bicheng HanFounder/Chief Executive Officer,BrainCo,ChinaYanan Hu General Manager of Internet Healthcare Department,JD Health,ChinaPing JiaFounder/Chief Executive Officer,Health Governance Initiative,ChinaLiming LiDirector,Major Epidemic Prevention and Control Strategy Research Center,Peking Universi

175、ty,ChinaChang Liu Regional Director for Greater China and South-East Asia,ASK Health,ChinaBiman Najika LiyanageChief Executive Officer,CirQ Technologies,Sri LankaChune Ma Co-founder/Chief Executive Officer,Shukun Technology,ChinaDjauhari OratmangunAmbassador of Indonesia to the Peoples Republic of C

176、hina and Mongolia,IndonesiaXin Qiao Chief Executive Officer,Deepwise,ChinaGuohong ShanPresident,China Business Unit,Takeda(China),ChinaXiaorong SunFounder/Chief Executive Officer,Landing Med,ChinaNinie Yan WangFounder/Chief Executive Officer,Pinetree Care Group,ChinaJing WuDirector,Chinese Center fo

177、r Disease Control and Prevention,ChinaYangfeng WuExecutive Deputy Director,Clinical Research Institute,Peking University,ChinaWeiyan ZhuFounder/Chief Executive Officer,Ningbo My-BioMed Biotechnology,ChinaAstraZeneca Mexico TeamsNCDs 2030:Accelerating Change through Innovation24ContributorsWorld Econ

178、omic Forum Shyam Bishen Head,Shaping the Future of Health and HealthcareShujing HeEarly Career Programme TraineeCarrie Liu Lead,Health and Healthcare ChinaKelly McCain Head,Healthcare InitiativesDuke Kunshan UniversityYunguo LiuCo-Director,Global Health Program,Duke Kunshan University Global Health

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216、-should-cervical-cancer-prevention-be-improved-lmics/2020-02.NCDs 2030:Accelerating Change through Innovation28World Economic Forum9193 route de la CapiteCH-1223 Cologny/GenevaSwitzerland Tel.:+41(0)22 869 1212Fax:+41(0)22 786 2744contactweforum.orgwww.weforum.orgThe World Economic Forum,committed to improving the state of the world,is the International Organization for Public-Private Cooperation.The Forum engages the foremost political,business and other leaders of society to shape global,regional and industry agendas.NCDs 2030:Accelerating Change through Innovation29